How Do Orthobiologics Fit In Modern Orthopedic Treatment? | Conversations in Regen Episode 27

How do orthobiologics actually fit into modern orthopedic treatment—and where should they be positioned in today’s evolving standard of care?
Discover more insights and resources here: Visit my Website : https://pxllnk.co/AD/BOBsite

In this episode of Conversation in Regenerative Medicine, hosted by Dr. Ariana DeMers, widely recognized as the “Queen of Business Orthobiologics,” she is joined by guest expert Dr. Ryan Molli to explore how orthobiologics are reshaping modern orthopedic decision-making.

This content is intended primarily for physicians, surgeons, and healthcare professionals involved in orthopedic care and regenerative medicine. However, patients and general audiences are also welcome, especially those seeking to improve patient education and better understand doctor patient communication in modern musculoskeletal treatment.

Dr. Ariana DeMers and Dr. Ryan Molli break down where orthobiologic treatments like platelet rich plasma therapy truly fit within the orthopedic treatment spectrum. The discussion explores how clinicians are integrating regenerative options into routine practice, how this impacts the traditional surgical pathway, and how evolving models of care are influencing orthopedic consultation workflows.

Key themes include clinical decision-making, treatment sequencing, patient selection, and the growing role of regenerative medicine in both conservative and interventional orthopedics. The conversation also highlights how physicians can better educate patients while improving outcomes through clearer communication and structured treatment pathways.

Building a successful cash-based orthobiologic practice is not a single decision. It is a series of the right decisions made in the right order. The Business of Orthobiologics offers three distinct programs designed to meet physicians at different stages of readiness — whether you are just beginning to explore PRP, ready to build a full practice system, or committed to going all-in on a comprehensive transformation.

Learn More here: https://thebusinessoforthobiologics.com/programs-explanation 

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Transcript

SPEAKER_00 0:00

I'm used to getting steroid shots every three months, but when you educate them about the dangers of steroids and the cartilage is destroyed by repeat steroid injections. So we're actually making the problem worse.

SPEAKER_01 0:11

That's a tough pill to swallow when you like finally dig and you're like, oh my gosh, how many joint replacements have I hastened? Oh sorry. Sorry, grandma.

SPEAKER_00 0:21

You know, our motto for our protocol is fear fades when the path is clear. So I truly believe we've been able to crystal clear paint the path for these patients. I was in a room for maybe, maybe five minutes. Now I'm in that room probably three, four, five times longer than that. And I don't leave until they have everything that they need.

SPEAKER_01 1:08

As we tackle some controversial topics uncovering cutting-edge insights that are shaping the future of interventional orthobiologics and cash-based practice. So I am very, very excited to uh bring Dr. Ryan Molly here to the to the stage today. And uh we will oh start meeting questions. Yes, we can do all of those things. So uh without further ado, while we are admitting everybody to the uh experience here, for those of you who don't know who I am, I'm Dr. Ariana Demers. I am a board-certified fellowship trained sports medicine orthopedic surgeon and regenerative medicine aficionado. I also do a lot of educating and training in both ultrasound, orthobiologics, and cash-based practice. I have been successfully able to move my rural Northern California practice away from insurance and I focus on cash-based procedures. And I am most passionate about helping doctors to incorporate orthobiologics and cash-based practice seamlessly in their practice. Uh, I am so pleased to bring to you Dr. Ryan Molly. He is the founder and CEO of Whole Health Orthopedic Institute in Medial Pennsylvania, founder of the Orthopreneurs Conference, board-certified orthopedic surgeon, fellowship trained adult reconstructive and total joint surgery uh extraordinaire. He did an AO uh trauma fellowship in France, and uh he has pioneered some very, very cool things, uh, including cash-based orthobiologics and orthopedic um integration. So he's been doing this for a couple of years. So without further ado, uh welcome, Dr. Molly. I'm so glad that you were able to join us today.

SPEAKER_00 3:16

Yeah, thank you for the invitation. Appreciate it very much.

SPEAKER_01 3:19

Absolutely, absolutely. I I'm always happy to have you know uh leaders, uh thought leaders in the field, people who are thinking outside the box of how we were traditionally trained to take care of our patients. So for the next hour, uh I'm really excited. So thanks everybody for joining. Uh, I'm we are talking about cash-based practice, regenerative medicine, exploring controversial topics. Uh and I think we'll be able to bring you some actionable insights that you can implement in your practice. And then of course, we will have a live QA session to get your burning questions answered uh from Dr. Ryan Molly. So I do believe that orthobiolatic treatments will be first line treatments for musculoskeletal care in the last in the next five years. So that is my goal. I got a lot of work ahead to make that true. But the train is leaving this station, and if you are not actively offering orthobiologics and cash-based care, uh, you gotta get on the train. So the problem is that sometimes uh successful integration is hard. Many of you are looking for a successful way to integrate orthobiologics into your practice. We do know that this is a great treatment for our patients, but how to do it successfully sometimes is more elusive. Maybe you've tried some things, maybe you're saying, gosh, I'm not sure about the science, maybe the techniques there's a high barrier to entry, ultrasound training, uh, maybe wasn't part of our uh training cash-based business, feels maybe daunting or overwhelming, marketing sales, and you know, maybe you just thought, I'm just not good at business, but it's not our fault because we did not learn this in school. That being said, it is a learnable skill. And so if you are struggling with how to successfully integrate orthobiologics and cash-based practice into your clinic, you are not alone. But definitely uh we're gonna share some insights on how to capitalize on this four billion dollar orthobiologics market out there, okay? So please put in the chat what you maybe are struggling with the most, and then we can address that at the end of this conversation. So the question is is how do we win? Uh, and we're gonna be talking a little bit about the perspective of a total joint surgeon and uh where we're going in the next 10, 15, 20, 25 years, and uh how do we provide whole person health? How do we do uh a better job at not siloing our patients and not focusing on you know the one thing uh to go really deep and oh I only do left knee replacements, oh I only do uh great toe uh procedures. And so when we aren't talking about that today, we also need to consider how we talk about this with our patients. How do we talk about cash-based care um when maybe our patients have different ideas about what's fair? Uh so this is gonna be be uh what we talk about. Clearly, we need a system, and we're not gonna go over all of this today, but we are gonna go a little bit further down this journey and and talk a little bit more about cash-based practice, about whole person health, and uh then we'll talk a little bit more about what that system looks like. So we are gonna get into this conversation. Uh, Dr. Ryan Molly, we have questions for you. Uh, if you can please uh tell me a little bit about your current practice model and maybe how you came to choose a concierge or cash pay. Because I know you've kind of been in transition this little bit. Uh so if you can share with us maybe the last five years, I know you've been kind of this evolution. That'd be great.

SPEAKER_00 7:51

Yeah. So uh thank you again, uh, Ariana, for the invitation to have this conversation. And uh I think this is an extremely valuable topic uh for many physicians out there that are maybe on that edge of dipping their toe in the water versus just going all in. So um I was kind of your traditional orthopedic surgeon, insurance-based, uh, up until about 2020. And um we all know that there is, and I have a private practice. I started my own uh private practice, whole health orthopedic institute on January 1st of 2018. Uh always kind of had this functional medicine whole health approach, uh, where we weren't just saying, oh, you've got an arthritic knee, you need a new knee. Really wanted to help patients with weight loss, uh medical optimization prior to surgery, because for me, it helped me reduce complications, which meant happier patients, which meant more patients. So it was always kind of baked into the practice, but the practice itself was very traditional, very insurance-based. And in 2020, after having some conversations with one of my college roommates who is, he's not an orthopedic surgeon, but he's a uh non-operative sports med doc. He was a team uh physician for Virginia Tech men's basketball team and one of their soccer teams for many years up until just literally the past couple months. He is an MDVIP internal medicine non-op sports med surgeon. So he has this concierge practice that I was very intrigued with. And then after having some more conversations with some uh fellow orthopedic surgeons who started their own concierge practice, uh these conversations were happening about 2019. In 2020, I decided, you know, I need to do something because with private practice, our cost of, you know, everything that we're offering and doing, whether it's our mortgage, our um all of our staffing expenses, uh the healthcare benefits, it continues to rise. And after COVID, all of our medical supplies it would rise, uh, all of our malpractice insurance, it would rise, and our reimbursements continue to decline. You do not need to be a accountant, mathematician to realize that this is a recipe for failure if you don't make any changes. And um, how do you make the changes? How do you do it in a fair way? And how do you do it where you can stay busy? So, what I decided to do in 2020 was to introduce a concierge model that was uh essentially an offering that if you wanted me to do your hipporte, you could either choose a traditional pathway, which was purely insurance-based, or you could do the concierge pathway. And the concierge pathway would uh bring with it such benefits as earlier surgical dates. So I typically would do about six joint replacements per day, three days a week, so 18 to 20 or 21 uh joint replacements per week. And I just kind of figured out my schedule where the demand of this got to be to the point where it's about 25% to 30% of my practice. So I would reserve four slots for traditional pathway patients and two slots for concierge patients, and they all filled. And uh they would pay me a cash membership fee for one year for the concierge membership. And uh not only did it get them sooner surgery, but it gave them direct access to me uh through cell phone, text messages, things like that. We uh included multiple different DME products that were not included or covered by their um insurance plans, and then uh just different concierge types of uh services. Like we would, I did some house visits for some of these people. Um, I would get all of these people a hotel very close to the hospital because I practice in a pretty rural area and our draws about three to four hours, so it would cut down on you know things like that so that they could not have to uh drive in the morning of surgery, and it worked really, really well. And I did that for about five and a half, almost six years, and then in July of 2025, decided to shut that program down, even though it was doing amazingly well, because I wanted to build something that was uh more fair, more um all inclusive, and it kind of took out what I call the paradox of choice, where people could either choose this versus this, and that's when we created the orthopedic journey, which we launched that protocol um and concierge program and on January 1st. So it is now if you want me to do your hip or knee replacement, you um you could choose to not have me do it, but if you choose to have me do it, you are going to be enrolling in our the orthopedic journey protocol, which is a five-step protocol. All the things I've learned over the past 16 years of practicing, what works, what doesn't. We have health coaches, uh, so we help with medical optimization, weight loss, smoking cessation, people that are malnourished, uh, people that are diabetic where their diabetes is out of control, and we optimize them before we give them a year access to uh a software app that I'm developing and uh just this entire package. We use perioperative nutrition and we've expanded all of the uh offerings of things that we give to them that are not covered by uh traditional insurance companies. Every patient gets a Fitbit, uh, all of our obese patients get a Bluetooth scale. Um, so we're literally setting them up for success for their recovery of their journey.

SPEAKER_01 13:28

Amazing, amazing. Um, so you know, when you kind of have this whole person health, um, you know, how how early they're like, okay, you they come to see a Dr. Molly, they need a joint replacement. How do you get um, you know, like how soon do you start? Do you start right away with all of this like pre-operative, perioperative optimization? Um, and then, you know, what have you ever had these patients where they're like, oh, now that I'm optimized, my knee doesn't really hurt that much?

SPEAKER_00 14:05

Yeah, so we do. We start uh before they ever come in for an appointment, brand new patients, hip or knee pain, they um get labs and we get a full panel of labs. We're looking at um, you know, nutrition markers, albumin, things like that. Um, if they are diabetic, we're we're getting, you know, all of the complete metabolic profile as well as um uh hemoglobin A1C. We're checking vitamin D levels on all of these patients. So we're starting optimization literally right out of the gates and assessing these patients and really trying to set an expectation from the get-go. I mean, I joke all the time, I say we're an orthopedic company that does a lot of hips and knee replacements, but first and foremost, we're an education company that happens to put metal and plastic in people's hips and knees. And um, you know, one of the biggest things that they get to is, as I was sharing with you earlier, is the nine hours of personalized video content and education that I've recorded, which took me about a year and a half to do that. And it's literally every topic you can think of from um perioperative nutrition to the importance of tight glucose control, both before, during, and after surgery to nicotine cessation, uh vitamin D optimization, things like that. So they they have full access to that app and those videos are given to them um in a very, very strategically positioned uh order so that they get a video every single day for three months around their surgery, typically three or four weeks leading up to surgery and two months after. And then the the second part of your question was are these people getting optimized to the point where their joints don't hurt anymore? Well, we also, January 1st, incorporated uh regenerative medicine. So it there was a lot of change changes at whole health on January 1st. It was kind of like a rebirth for the practice with our protocol as well as the regenerative medicine uh part of the practice. And um, I've we've seen some amazing results with the regenerative medicine piece, where I'm thinking me five years ago, these people absolutely need a joint replacement. And my conversations changed with them, and I really started to have deeper, more meaningful, longer conversations with them to see what they've tried, what their goals are. And after, you know, kind of a personal experience with um some regenerative medicine myself, I saw the powers of it and I was like, the body, and again, just my functional medicine, like brain, it's like the the body's innate ability to heal is probably one of the most amazing things, you know, that I is on planet Earth, right? Like we as orthopedic surgeons, we think, yeah, we we we healed that broken bone. No, we may have put a plate on it or put a rod down through the bone to put it in position, but the body healed the bone, right? And the same thing before antibiotics were discovered, um, people didn't die from every single infection that they got. They rarely died, and the body had an immune system that was able to fight off the infection. And so when we started thinking about orthobiologics and the power of orthobiologics and how we can create a regenerative process um that doesn't always require metal and plastic uh as the end result. I mean, I think it's an amazing thing to offer to patients, and it's the right thing to offer to patients.

SPEAKER_01 17:29

Awesome. That's that's fantastic. So do patients really want surgery or they just want that function, that mobility, the longevity? Is that what they're looking for when they come to see you?

SPEAKER_00 17:42

Yeah, I don't think that anyone really wants surgery, and if they do, maybe they've got a couple crazy screws loose up in their brain. Um, they they want the results.

SPEAKER_01 17:50

Bummer, like that's the cut, that's the the solution I came to as well. It's like, dang, none of my patients actually want what I'm offering. Yeah, they don't actually want surgery.

SPEAKER_00 18:02

They they want the end result that surgery can bring them, which is kind of a restored life, which is uh our our last step of the orthopedic journey, which is they want to be able to go to the ball games for their grandkids. They want to be able to go out and get the mail, they want to be able to play tennis with their their buddies or or go shopping with their girlfriends. So they want that quality of life back. And yes, hip and knee replacement surgery, that's that's what I do, has done an amazing job of being able to provide that, but it also is a major operation, has inherent risks um and complications that can be absolutely devastating, most particularly infection. So if there's a way that we can either delay it, um prevent it, or optimize it, right? Like a lot, I don't think that we're ever going to be getting away from joint replacement or surgery. I I just I don't believe that, but I do believe that regenerative medicine and uh orthobiologics are going to really, really augment and enhance, even if we do do surgery, the biologic recovery that is uh uh available and possible, whereas before it was just like, well, we'll put the minimal plastic in and let the body just the time will heal it. But I think we can augment.

SPEAKER_01 19:22

Awesome. Well, I still have more questions. So do you think um, you know, when you look back, what are you so glad that you're able to offer now with your um orthopedic journey protocol and maybe regenerative medicine options, whole body health, whole person health, that has been the biggest limitation of insurance-driven care.

SPEAKER_00 19:53

Yeah, I think before it was, you know, just get on the treadmill, the hamster wheel, run away, increase your volume. And that that was the only way that it mathematically was going to work out, right? And a lot of employed physicians, they know that model very, very well. Being private practice, I do have the luxury of controlling my own schedule, how many patients I see, how long I spend with every patient. And I will tell you that I spend a significant amount of time with them compared to what I used to spend with them um, you know, five or six years ago. Um I was in a room for maybe, maybe five minutes. Now I'm in that room probably three, four, five times longer than that. And I don't leave until they have everything that they need. They have the answers that they need, they have the time um uh and just the that energy that needs to be brought to them. And I feel like this transition has allowed me to practice much better medicine, right? Like the type of medicine that I want my mom or my dad to receive. And when I created the orthopedic journey, like the whole idea was about all right, if mom or dad ever need a hip or knee replacement, how do I want my mom or my dad to experience that care? And I don't want it to be cold, I don't want it to be impersonal, I don't want it to be rushed, I don't want it to be fearful because I think surgery is easily one of the most scary things that these patients are um you know experiencing. And, you know, our motto for our our protocol is fear fades when the path is clear. So I truly believe we've been able to crystal clear paint the path for these patients through these five steps of what it looks like. And with the video education, which we've had unbelievable feedback. I mean, the patients love getting a video from me every day, even though I spent a lot more time with them face to face in the clinic. Now they get to see me every day. And um, those videos are short, they're to the point. They're one topic per video. They're maybe on average, I'd say about five minutes long. Some are a little bit longer, um, some are a little bit shorter, but they really appreciate those touch points. Really appreciate the fact that they can reach out to me. Every single patient now has direct access to me through the app. They can they can message me through our HIPAASecure chat option within the app. They can access my team as well through the app. We can give them important reminders about upcoming appointments, instructions before surgery, so that we don't have someone eating, you know, the morning of surgery. We don't have someone not taking their perioperative nutritional supplement the correct way before surgery. We got away from all opioids. This is like the most new development. About three weeks ago, we started using Gernavex on 100% of our hip and knee patients. And none of our patients, I think, other than one or two that just blatantly refused it, um, have received any opioids or narcotics. And we're having tremendous success with that too. So I just think that it's allowed me to go back to the roots of practicing really good old-fashioned medicine of taking time with patients, giving them all the options, right? Before it used to be, here's a steroid shot, we'll do that every three months until you're ready for surgery. Now I I high I have signs in my rooms that say I I don't want to inject you with steroids anymore. And we we will do it if it's a special occasion, right? You have a wedding, you have a trip coming up, but other than that, my best options for you are an orthobiologic option, whether it's PRP, uh PRP with MFAT, or you know, uh boom, uh marrow aspirate, versus, you know, are you ready for surgery? And the the option, the adoption I thought was going to be very like resistant, like hey, I'm used to getting steroid shots every three months. But when you educate them about the the dangers of steroids and the multiple studies out there that have shown that you know the cartilage is destroyed by repeat steroid injections. So we're actually making the problem worse.

SPEAKER_01 23:58

I know, I know that's a that's a tough pill to swallow when you like finally dig and you're like, oh my gosh, how many joint replacements have I hastened? Oh sorry, sorry, grandma.

SPEAKER_00 24:10

Exactly.

SPEAKER_01 24:11

Um, well, that it this is so fascinating to me, and I really do, and this is why I invited you on because you are now embodying I a new way to practice orthopedics. So, what do you think that successful joint replacement practice looks like in 2035?

SPEAKER_00 24:33

Yeah, I think it's gonna be whole whole health and whole body uh oriented. I think that for so long we have focused on the day of surgery, that 45-minute procedure. Um, on average, right? Most most joint surgeons that do a lot, they're 45 minutes, maybe an hour, maybe 30 minutes. But why why do patients and why do uh physicians and providers spend so much time focused on this? And yes, I do believe that I'm a huge muscle-sparing advocate for both hip and knee replacement surgery. Um I'm I design implants for implant companies. So I think how we get to the joint matters. I think how we put the implants in matters. I'm a huge kinematic alignment guy. Um, and I think what we put in matters tremendously. But at the end of the day, I think the preparate, the preparation phase and the guided recovery phase are way more impactful. And you can screw up a really good operation if you don't prepare well or you don't guide them after surgery well. So I think what patients are really looking for, and ultimately what physicians are going to be looking to provide is literally the entire gamut of care from the first moment that we meet them to you know offering all options, whether it's regenerative medicine, whether it's more traditional uh conservative care versus uh joint preserving procedures versus joint replacement procedures. But when we get to that surgical phase and we're talking about a joint replacement, it's not going to be focused on, hey, do you use a robot or do you this? It's gonna be focused on what's your perioperative nutrition look like, your protocol. How what are you doing after surgery, right? Are you doing the old no pain, no gain postoperative therapy protocol, or are you doing more of um, you know, our protocol is very similar to Andrew Wickline's less swelling, less pain, where I for the past 10 years, my patients for the first three weeks after hip or knee, they lay flat on their back 80% of the time with their feet above their heart, and we control swelling. And by controlling swelling, we reduce pain, we improve motion, we reduce complications, such as blood clots and things like that, because we're using gravity, and the patients are much happier. So I think it's the whole spectrum, it's not just the day of surgery anymore.

SPEAKER_01 26:55

That's amazing. Well, clearly, I have more questions for you. Uh, this has been uh definitely a mind-expanding conversation and so encouraging that we are moving the needle on how we think about an episode of care, how we think about our patient as an actual person from start to finish, how they experience our profession. And, you know, I agree as I've gone along this journey into orthobiologics and regenerative medicine, I can tell you hands down, I am a much better doctor than I was 10 years ago. You know, I come home, I'm like, man, I did some good doctoring today, like real, like real life doctoring, right? Uh so it's been it's been fascinating. So, how do you see orthobiologics fitting into that continuum of care between that conservative uh care and that surgery? Like, what's your kind of thought process or algorithm when somebody comes into your practice?

SPEAKER_00 28:00

Yeah, so I mean, I think the the previous was, are you ready for surgery or not? Right. And that's the patients would always ask me that. They're like, what do you think, doc? Do I need a knee? Do I need a hip? And I would always tell them, is like, I don't know. You'll tell me when you're ready for it. I said, There's three things to me that make up a really good physician. I said, number one, we have to use these, what God gave us on the sides of our head. We have to be able to be good listeners. So I spent a lot of time listening to my patients and um reading surveys, questionnaires that they filled out to see what's bothering them. And really one of my biggest questions is what's their number one goal? What do they want to be able to do that they can't do now? And then once I understand that, then it's like, all right, well, what's the next step of being a good doctor? I think we have to use these things. Um, and you and I are both osteopaths, so we've been trained with our hands. I've seen so many surgeons go into a room and they don't even lay their hands on a patient. They don't examine them. So for me, I'm assessing, you know, uh swelling, I'm assessing uh ligament ligamentos stability or instability, I'm assessing crepitus, I'm assessing uh range of motion restrictions, tightness, thing, tissue quality, uh, are they really edematus in their ankles? Um, I'm using my eyes to examine them too. And then the third thing is what they all focus on are my x-rays. What are my x-rays showing me? And I say, I it doesn't matter what they show, I can tell you what they show, but the x-ray isn't a quality of life. It can it can be a severely arthritic knee or hip. But if you're still living a pretty meaningful life and it's not creating more bad days than good days, then I wouldn't do a joint replacement. And if you're struggling in the simple things like maybe some Motrin or Advil, which is not totally benign, by the way, right? I mean, we we have people with declining kidney function, people with uh hypertension, metabolic uh disease that are coming in here. So it's really becoming that physician again. And I would agree with you, Ariana. Like I feel like I'm a much better physician now than I was 10 years ago or even five years ago, because I was I was becoming very much a technician, right? Here's the problem, here's the solution. The the joint is arthritic, I'll replace it. And now I feel I'm more I tell my patients I'm a physician first and foremost, and I'm a surgeon secondarily. That doesn't mean that I do any less surgery or that I enjoy doing surgery any less, but there is this middle ground, and that's where regenerative medicine, I think, really, really has this amazing ability uh to augment uh patients' care and uh physicians' practices, right? Um, the the fact that it is a cash pay, um, some people may see that as an obstacle, other people see that as a solution, right? And I think as long as you educate and you tell people, hey, listen, um, this isn't covered by insurance, but these are the benefits of it. And you do you see people spending tens of thousands of dollars on certain procedures and they're not getting much relief, and then other people offering things at a much more reasonable rate and getting great results. So uh I think it is uh it's a great opportunity for uh again patients and providers together.

SPEAKER_01 31:29

So hello guys. I had to be um on my phone. Um this is the so we were talking earlier about rural uh California. And the one thing about rural California is that we have an unstable power grid. And we now have no power, and so my internet's out um in uh first world countries. So here we are um and on uh choice two.

SPEAKER_00 31:57

That was a good question fixed.

SPEAKER_01 32:00

Well, here I am. So um, yeah, we are and we have other friends here, so I'm I'm so glad. So I do uh we were talking about how um you know where do you where do you see it? And do you think you know you don't offer cortisone unless it's an emergency, and you're offering regenerative medicine as this bridge. Um what what percent of your patients are saying yes to regenerative medicine first?

SPEAKER_00 32:32

So um again, January we had a lot of changes at the practice. Um we started the protocol, we also started the regenerative medicine. So I went from not seeing any new patients myself. Uh I have five PAs in my practice. They saw all the new patients and they would do all the conservative care until they needed surgery, then they'd send them to me. When the protocol got rolled out, I felt like I needed to be in control of the conversation and the discussion. So I saw 100% of all new patients, and um, it was a very different role for me. And I was the front and center talking about how we're gonna what we're gonna do next. Here's here's the options, here's what I recommend. So I was the one that was kind of selling and uh educating on the uh the regenerative medicine piece. Um as time went, and it was about uh early April, so we gave it about three months, um, we realized that we needed to make some transitions. It's like you think this is going to be better, but then you do it and you're realizing like maybe there's a hybrid. So we actually went back to the old way where the PAs started seeing all the new patients. Um, unfortunately, the regenerative medicine enrollment definitely went down. Um, I think they're just not used to or comfortable having those conversations as much as I was, even though um, and it's like old dog new trick, right? Like they were so just used to steroid, steroid, steroid, steroid, steroid, or um visco supplementation but without any use of this. So I sent two of them to a regenerative medicine course um to get them educated on it, and they they've adopted it better, but it's still not as high as I would like it to be. Um so I know I kind of answered your question a bit, but um we're we're still like in the infancy, right? We just started month six of the year. Uh so we're figuring it out as we go, but the implementation, patients are now coming um and asking for it because we are marketing it a bit. You know, it's on our website now. We have a regenerative medicine tab. We have regenerative medicine uh brochures that we've created that are in every exam office. I have uh kind of a warning sign talking about steroid injections, especially leading up to joint replacement. And uh I have a TV in every single room, and we're we're just we constantly are just educating on what we do, how we're changing, but always trying to get better.

SPEAKER_01 35:12

So imagine it's 2035 and you are looking back on the decisions orthopedic surgeons made in 2026. What are uh, you know, through that lens, what do you think they got right? And maybe what uh what did they still miss?

SPEAKER_00 35:33

Um, I think that there is this push, this transition of uh regenerative medicine. I think there's a push for the entire episode of care, the perioperative optimization piece. I think there's a I think it's a small percentage of uh traditional orthopedic surgeons that are getting it and embracing it. And the ones that are, they're like, yeah, this is the way. Um, so I think that number will grow as it just gains traction. Um, so I think that in 10 years will be a much bigger piece of individuals' practices. I think where we're still getting things wrong is we're focusing a lot on uh technology, and I'm guilty of this. I you and I had a conversation conversation earlier about how I'm creating an app. Um, I do think that technology can be really, really helpful and beneficial to um help educate patients and help us with precision and things like that. But I feel like there's just so much focus on whether it's robotic surgery, whether it's the latest, greatest widget to uh make a surgery. Again, I I think there's just still too much emphasis on the actual surgery. Um, and we're we're not spending enough time or energy on the the deeper, more meaningful conversations of before and after, right? I think as uh I think the bubble's gonna burst too in terms of uh traditional healthcare, and I think it needs to, um, in terms of the insurance plans, because to think that every surgeon's going to get reimbursed the same amount, yet our outcomes are very different. I mean, it's there's a bell curve in life. There's there's really, really, really talented, very good surgeons. There's some that are probably shouldn't be doing surgery, and then there's the people in the middle. And uh I think it's that's their technique aspect, but also how they approach medicine and education and this and that, and perioperative optimization and post-operative recovery protocols. So I think as we focus more time and energy into the entire patient experience, uh patient outcomes are going to increase. And I think that the the bubble's gonna burst in terms of insurance and uh some different type, and I don't know what it will be, whether it's it's not gonna be all cash bay for sure, but I think there will be different compensation models based upon results, which I think that's how it should be, right? Like professional sports, every single player doesn't make the same amount of money, uh, because there's some that are really, really good, and then there's some that are role players, and then there's some that are bench players. And they're the same thing as in medicine. So I think the most talented, the most uh committed, the most dedicated, the ones that are working the hardest, the ones that are moving the needle the most should be rewarded the most.

SPEAKER_01 38:32

Yeah, absolutely. So what would you tell, you know, an orthopedic surgeon that is on the fence and they're like, gosh, uh I really want to add it, but I'm I'm I'm nervous, I'm scared. People uh like, how do you talk about it? How do you talk about the money piece? Like, what do you think um is way more simple than we think it is?

SPEAKER_00 38:59

First. Yeah, yeah. I mean, I honestly I remember my conversation with you when you were on my podcast several years ago because I wasn't doing this at that point. I I had a concierge branch of my practice, but the regenerative medicine piece seemed scary, right? Because people were so used to stero injections or just things being covered by insurance. So my first uh toe in the water was the concierge piece, and it was an option, right? It wasn't mandatory, and so I felt like that was an easy like way to kind of break into it was to say, hey, and I had a major problem. My my wait time was excessively long. So it was either I do this and give some people the opportunity to move up sooner in the in the wait time, or I'm gonna start losing patience because they don't want to wait that long. So it was like, I'm damned if I do, damned if I don't. And I chose to uh what I felt was the lesser of two evil evils, but also something that would help me uh from a private practice standpoint, which was improve the reimbursements, right? And improve the the experience. And my my happiest patients were my concierge patients. They had more time with me, more FaceTime, they had direct access to me. Um, so when I started seeing that, I was like, these people really like this. There were some disgruntled people. I'm not gonna lie and say that everybody bought into it because they didn't. Again, you and I talked about that before. I think there's just some delusional people out there that think everything in life should be free, and that's just not the reality. And people pay for convenience, people pay for quality, people pay for this or that. So um I just kind of came to that realization that I and also I wanted to really enjoy the work that I was doing and felt valued in in the in the work that I'm doing and not taken advantage of by a system that I don't have any control over. And you know, I'm I'm a private practice too. So um I don't like being told what to do uh by administrators that have never been in the trenches. So I've always kind of been that like entrepreneurial guy. So I just said, you know what, I'll have these difficult conversations. And as you have them, they get easier, they get much, much easier. And and it honestly only took me a couple weeks to kind of find my rhythm and my groove. And I would say, rehearse it, right? Just like anything. Rehearse it, have a conversation with your wife, uh, your husband, have a conversation with your practice manager, have a conversation with a previous patient that you are have already operated on. Um, and I would say one of the errors that I did initially with everybody was I went into the the healthcare saga, right? Like the the oh poor me. I wasn't trying to be oh poor me, but I was saying what the reality is of declining reimbursement, increasing costs of running a private practice. And quite frankly, people don't care, right? Some people do, but few and far between, and they just don't care. So I'd say save your time and energy, don't even go down that path. If people start giving you pushback and saying, oh, this isn't right, you're charging this, or you're only accepting, then I think you can go into the business because now they're they're they're actually talking about the business. So it's opening the door of that conversation.

SPEAKER_01 42:22

Absolutely. You know, I'm I'm more than happy to uh be transparent about what their insurance company is actually reimbursing me. And they're always up in arms. They're like, well, what what should we do? I'm like, well, call your representative. Um I mean, this is a contract between you and your company. Uh, if you don't like what the company is reimbursing, you should probably tell them. Uh so that's uh really good. I think one last piece of advice, and then we'll go to some QA. Um, is like, what do you think the next best step? If someone's like, shoot, man, I if if Ryan Molly can do it, I can do it too. What do you think that next step is? What what should they do tomorrow? And be to be like, okay, I I think I can do this. I'm gonna do X.

SPEAKER_00 43:13

Yeah, I think it's just like having the confidence and believing in yourself, right? So I I tell people all the time, I'm not a Vegas fan. I I I'll go there for the shows and the food, but I I don't gamble and I have no problem with people gambling. The only thing I have ever gambled on in my life is me. And I feel like I can control that, right? I can't control a craps table, I can't control a poker table. I can't so for me, I know that I'm gonna show up, I'm gonna do the work, I would do your research. And if you're in a private practice setting, it's just like well, you either control your destiny or your destiny is gonna control you, and you either make these changes. And I would say like the probably the safest way is to do um maybe some type of hybrid model before you go off. in and uh you know that's kind of what I did when I started the the concierge um branch of my practices I still accept insurance right so your in sh your your cash pay concierge doesn't pay me to do your surgery it has nothing to do with that it's all the additional things that it that it covers and with our our current protocol we have a concierge membership agreement that you have to have a really good healthcare attorney to make sure that everything is on the up and up and quite frankly my protocol you and I were talking earlier offline uh Ariana I charge them half of what I used to charge them and they get 10 times more than what they used to get so I'm probably charging way too little but um I think it's a really good start point. I I would not outprice yourself but don't underprice your value either you you need to know what you're worth and I think just do your research if it's gonna be regenerative medicine do do some local regional research to see what other practices are are charging for PRP or whatever the the level of care is that you're looking to kind of match and and be competitive with it.

SPEAKER_01 45:11

I I I don't think I would be super cheap on it because then they're gonna create questions as like well is that just not as good or or or whatnot like be competitive or blue ocean uh and avoid you know class of one and then and then you don't have to worry I think a lot of I do think uh and I will speak out against this is I I think a lot of physicians underprice themselves uh don't know their worth and um charge way less than they they should for these services we've done a lot of work looking at regenerative medicine and pricing in a private practice model and we when we look at it all things told the cost of goods is not the only cost that goes into it and and so that's usually what is calculated and people go well the kit costs this so I'm gonna do two times kit or three times kit but the the overall um costs are are significantly higher and so we've done across the board calculations for all of my uh physicians who I coach and it's come up with the same number for every single private practice physician break-even rate is 2100 for PRP uh so so I'm just gonna I don't know what you charge but you take that to the bank and uh make sure that you're charging what you're worth that you're not undercharging and we don't want this to be a race to the bottom we are not Walmart this is high um acuity personalized medicine and you've put a ton of thought and care into the journey into the patient's experience into the outcomes you are so so so keyed in to those outcomes of course you should be you know reimbursed accordingly to all of that hard work and expertise and knowledge and courage to be able to provide this service that's very different than the status quo 100% awesome well I I think we have we're gonna go to QA um and we'll go uh from there so if anyone has any questions um I'm I think here we are you can just raise your hand there's no open questions I'm clearly doing this on my phone which is really impressive uh we have maybe one chat everyone uh if we don't have any questions I'm gonna keep asking him questions um because I'm fascinated so tell me this um when your you know your your PAs are seeing your patients um oh good we'll get that um when your PAs are seeing your patients what do you think is the biggest hurdle for them to kind of wrap their mind around um what what makes it different for them to talk about regenerative medicine versus you I think it's just the fact that again the old dog new tricks like one of my PAs um has been a PA for close to 40 years now and it's maybe part of the I've been doing this my entire career and these patients seem to do well and I they come back every three months because the this the steroid shot works and they're they're repeat customers versus like this new uh option which really kind of maybe in their head is thinking like have I been mismanaging these patients for close to 40 years right and and that can be like a harsh reality right where you're just like oh right I mean we used to use wood for hip and knee implants too and that didn't work out so well. So um we've done all sorts of uh things that were maybe a bit questionable exactly right so that's what science is for right so that we can continue to to you know keep up with the the pace of what's happening.

SPEAKER_00 49:19

Yeah I think the other piece too is like just the lack of ownership right so when I'm having a conversation I know what's going on behind the scenes and what the practice looks like from a financial standpoint. Um again that my my employees yeah they care about the health of the practice but they don't care care about the health practice and they think that they care but at the end of the day it's what's best for me, right? What's going to be easiest for me? What's the path of least resistance that I can keep doing the same things I'm doing and just stay on the seti eddy of making the same and I've incentivized them um you know I've said for each patient that you sign up for whether it's PRP or a PRP with um THAT or BOM like you get X percent of the fee. So it's like and that's a million times more than what you were getting for a steroid injection right so it's what's good good for the goose is good for the gander. I I feel like rewarding them it and it still hasn't produced the results that I thought it would because I was like oh they'll be ecstatic with this and it's just like you you want to raise every year you come to me you want more bonus well here's an opportunity but it's just that deeper conversation that they have to have and maybe they're just resistant to having that conversation or spending more time. I I don't know.

SPEAKER_01 50:43

Yeah you can answer that for me I don't know I I do think it's partly education. I think the more I think you're gonna actually what you're gonna see is they're gonna get wins for the patients that they they converted and they're like ah Mrs. Jones is doing so good and then they're gonna be on board. Um because then they're gonna be like I'm I'm a I want more of this because that's that's what our experience right is like oh my gosh this is so good. How how can we not offer this right the outcomes are are phenomenal.

SPEAKER_00 51:16

So I think maybe just time and and more experience with the ex with the new quote new stuff is going to give them the the confidence to be able to talk about it more um clearly so there's some questions uh what is your best marketing tip for regen and like how important is social media Sir Social Media King Yeah I so I haven't done a ton of uh marketing for regenerative medicine on social media yet um like I said we updated our whole website this year just because we have so many changes with the protocol we added regenerative medicine on there um we have a marketing guy that goes out in the community we're doing an event here in a couple weeks uh where we're we're offering it to uh other providers but also to lay people the patients where we're gonna talk to them about our practice all the services that we provide including regenerative medicine um I I'm I do think that there is a place for it in the social media world I I think you Ariana probably could answer that better than I can just because you've been doing it a lot longer than me. But I just I we haven't tapped into that yet. Yeah absolutely I think I think it depends on uh when you're talking about regenerative medicine um I think education and you're you're doing the education and so that translation um is the same whether you're educating about why they can't have a steroid shot why they have to uh do perioperative care before they're uh a procedure it's the same thing uh you know anytime you want someone to change you have to have so much education that goes into that about what it is why it's a better choice why you're the better choice for them uh to just continue to build authority and build trust for the your patients uh there is a question there's two questions how did you get around being in network with insurance and often cash con cash concierge services at the same time yeah so uh again it it you it's not one or the other you can it's all about how you set it up and how you set your agreements up with your concierge patients so again we're not charging patients additional money to do their surgery their insurance company pays for their surgery their insurance company pays for the global period their insurance company pays for certain DME equipment which is not a whole lot right they're not gonna pay for ambulatory SEDs they're not gonna pay for any type of uh cryocuffs or polar care type of units they'll pay for a walker they'll pay for a cane uh that kind of stuff they'll pay for uh a range of motion brace if you need that um so you can build it but and and this is where again having a really good healthcare attorney can help you build your concierge agreement uh so that there's no crossovers there's no questionable double belling or double dipping whatsoever and that's where that hybrid um dipping your toe into the water I think is is it's the route that I chose to take and maybe it will lead me more towards a a pure cash-based practice down the road but I think where I live too it I would be abandoning a lot of patients just because um I'm in a very very rural area a lot of blue collar workers and uh there's just a lot of people that wouldn't be able to pay like you know X amount of uh thousands of dollars for a cash pay procedure um they may be able to pay the professional fee but are you gonna be able to pay the facility fee right and that's now you can still be uh out of network with the professional side of things but in network with the facility so there there are ways to do that and um we we looked into that as well but it can get a little confusing uh to patients at times when they're getting their EOBs and things like that so we just chose the hybrid model for now and we'll see where things go.

SPEAKER_01 55:23

Yeah absolutely oops whoopsie the the trials and tribulations of doing it on your phone so entertaining um so ultimately there is one more question um you know there there was a question like how are you coaching your front desk to get labs first when patients want to be seen because there's their knee is hurting like how are you how and I have this question too like how are you obtaining um labs or exercise or something that's outside because especially if it you've never met this person like how are you how are you going about doing that?

SPEAKER_00 55:59

Yeah so it's just part of our protocol right so we're saying hey this is why we're doing it so it's education right so we're having that conversation and uh my director of our well so I have a wellness institute in my practice too so I think that's an important distinction a lot of practices don't have that so when patients call they're talking to the front desk they're not necessarily doing this we have somebody um in the wellness institute that schedules all new patients um they will talk to them and say you need to fill out this questionnaire you need to fill out this piece of paperwork and one of the other prerequisites is Dr. Molly wants to do a full evaluation he wants to see the entire picture right I get it that your hip or knee hurts but if your hip or knee hurts and you come in and you decide yeah you need a hip or knee replacement and then a week later we get your labs and we find out your A1C is 9.8 and you're nowhere near getting a near hip or knee replacement, you're gonna be really, really discouraged. So we want to set the expectation from day one. So I need to have the full picture of what things look like before I can really sit down and meet with you to have those realistic conversations, right? Because if something's way out of whack like your albumin's you know 2.9 you're not getting surgery by me anytime in the near future until we can get that up and I don't want to disappoint you I I'd rather have the conversation with you face to face and educate you on why this is important. And if you choose to go somewhere else and they just ignore it and and do it that's fine. But I I I honestly have not seen hardly any I don't remember one patient that had a hard time getting laughs before the uh initial appointment it's it's all about setting expectations very clearly and I've created videos about this too. So when you go on our website I've explained it so they're not hearing it for the first time maybe they go to our website they say oh this place is all about functional medicine all about whole health and it's just part of their criteria. It's part of their protocol. Gotcha there's a question about um stopping alcohol or cannabis or adding supplements prior to uh the regenerative procedures or even surgery for that matter um I'll let you touch on the regenerative procedures because I don't have um a big stance on that I I do have them stop all uh non-steroidals you know uh well in advance um I don't have them stop cannabis I don't have them I mean I don't think that they should be drinking excessively before it anyways um but in terms of the surgical stuff uh we are getting a complete social history of them um I do not operate on anybody that is actively using nicotine and I make them stop four to six weeks prior to surgery and I tell them I want them to be nicotine free for six weeks after and we do monitor we do check uh those patients before with uh a cotinine level and if it's uh if it's elevated we cancel their surgery and reschedule it.

SPEAKER_01 59:02

And I I think that's not wrong. You know, for my regenerative patients I put the I optimize um ahead of time four weeks ahead of time uh I ask them that no alcohol no tobacco um cannabis I I would prefer that they not uh partake with the cannabis if they're undergoing cartilage based uh treatments because we know that it has been uh detrimental uh and they continue supplementation after their procedure as well you know vitamin D, berberine, um all of these uh supplements uh you know that are helpful for cell chemotaxis uh as well as cellular health and wellness um and really making sure that your blood sugar is stable they're on a regenerative medicine protocol for me from a from a um diet and uh exercise we do in-body scanning we do all of those things ahead of time to make sure that they're fully optimized before we they undergo regenerative therapies with us but just makes sense you know you're wanting you are wanting the body to be as well optimized to heal as humanly possible uh and we know alcohol is a direct cellular toxin uh so it I think it's it just makes sense there well we'll wrap this up um uh this final question do you get the labs from Quest do you get labs from your hospital what labs do you get I think you you went over that you get uh an albumin CMP hemoglobin A1C vitamin D. Is there anything else that you is on your standard protocol?

SPEAKER_00 1:00:38

C CBC with diff. You know I want to make sure that they're not anemic or anything like that going into surgery. Those are the standard labs that we get we draw all of them in our uh office as well because we have the wellness institute we have EKG machine so and 100% of all of our pre-surgical um medical optimization and I hate the word clearance but I'm gonna use it clearances get done by uh my PA at our wellness institute we do not use any primary cares internal medicine doctors I went away from that over 10 years ago it just created too much confusion there was too many Friday nights hey can I get the HP and clearance from your office and it wouldn't get faxed over in time and then there were surgery cancellations for Monday so I brought it all in house with the wellness institute so that they just know that is part of the protocol.

SPEAKER_01 1:01:29

Very nice very nice well uh you know thank you so much we are uh over time uh to be expected you're amazing and you've uh really been thoughtful about how you take care of your patients uh so I really want to thank you again uh this has been phenomenal and I will look forward to our continued conversations and uh looking forward to hearing more about your successes with regenerative medicine in a total joint practice. It's so awesome.

SPEAKER_00 1:02:01

Congratulations thank you and thanks again for having me on. I appreciate it.

SPEAKER_01 1:02:05

All right everyone else thank you so much uh take care we'll see you in two weeks for the next conversations in regenerative medicine and uh we look forward to taking the the continued questions about how do we do this and uh succeed for our patients and for ourselves. So have a great night guys we'll talk to you soon